Senator O'Mara's 2023 Women of Distinction Nomination Form

February 06, 2023

Women of Distinction

Name and Address of Nominee *

Name of Nominating Individual *

Organization and Title of Nominating Individual *

Address *

Telephone *

E-mail *

Please provide the following nominee information

Birthdate *

Place of Birth *

Present Occupation *

Past relevant occupations *

Community, Civic or Business Service, Awards and Recognition *

Military Service (If Applicable)

What do you think has been your nominee's major accomplishment(s)?

Please use this space to provide a short statement of support for your nominee

Please include a photo and any awards and commendations as well as any other information pertinent to the nomination. *

This information will be used to create a plaque and booklet recognizing each nominee and will be considered when selecting the 2019 Women of Distinction honoree.
Files must be less than 8 MB.
Allowed file types: jpg jpeg png pdf.

Leave this field blank

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